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HomeMy WebLinkAboutBuilding Permit #597 - 19 OLYMPIC LANE 4/6/2010 BUILDING PERMIT o*OO oT"qti TOWN OF NORTH ANDOVER c� 4`::''. „�', o° APPLICATION FOR PLAN EXAMINATION 70 Permit NO: Date Received �SSACH�1`��� Date Issued: q IMPORTANT:Applicant must complete all items on this page LOCATION f / 0f Yme/e- Z°7N�e— Print PROPERTY OWNER POM ep C 7—e r-r4po � "T Print MAP 210 M6 � PARCEL: ZONING DISTRICT: Historic District yes no) , Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building k--�ne family Addition Two or more family Industrial Alteration No. of units: Commercial repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District " AVVater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: ow s o/,J 0,0J* -Y � /� dentification Please TyP�,a or Print Clearly) / p OWNER: Name: X)Otyi r�i c- -i �S rfl- 'a, Phon4970 d (0 Address: a l /y i - L-T^.) 2____ CONTRACTOR Name: > We is Phone-610S' _ 3S Address: Ad, o3el Supervisor's ConstructionLicense: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 6tao FEE: $ Check No.: 03— Receipt No.: W NOTE: Persons con racting with unregistered contractors do not have acce s to the guaranty nd :Signature of Agent/Owner Signature of contractor Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS A Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp'Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use) ❑ Notified foricku - Date p p ...-_...............--...................................................................._......_..............---..._...................................._......__.....---............---....._...........................................................--...---....._.............._................................................................................---..._...................................._......... Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 4 Location L Date J No. � NaRTM TOWN OF NORTH ANDOVER ,0 9 Certificate of Occupancy $ • i-- ;�s°•^°'t<� Building/Frame Permit Fee $ " +c Mus J Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # f / 225U _ Building Inspector Proposal Page No. Of Pages �fa��L�iPrvveMPw� BRAD POWERS CONSTRUCTION 1009 �o N Tr9 cTo /2 22 Wymans Landing 6Zesis j rg«oN� /o2d77�p DANVILLE, NH 03819 1 q v rem (603) 642-64289(603) 235-7986 Massachusetts Home.Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice If necessary. Any person planning home improvements should first obtain a copy of"a , Massachusetts consumer guide to home improvement"before agreeing to any work on your residence-You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1=888-283-3757. Homeowner Information Contractor Information Name ^ s ompany Name �ar�ie,v�C 6�iPN 1err,9,AjoV0- 1S94D overs- CaNS i r'uCTio,&) Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name l'L Cityfrowo -e State Zip Code Business Address(must include a street address) Daytime Phone Evening Phone fityrrown State Zip Code Mailing Address(It different from above) =Homeo ness Pho (p -6f ederal Employer ID or S.S.Number "uims that mon home®- Home provemeet Contractor see,Number Expiration date Cot connector have a mgiahadom numbs6� cR 7 7 /_The Contractor agrees to do the following work < < (Qm e o p e g7en o 3 /J e JAJ j 1JWe I'leN (/v/AVcJOJYJ S" 400 S--ries- Do u.,a/e. /yv New (2 , eca!a�' A ri^^eeQ C-/gyg W Ork TO .✓e- t161-je_ O/v 6i--T4 s/�r��96/� e,�eQ cckrt-tAjeY &No) PAI'li 7- Allvim' oli 7-4;s ewd P- Li®vsA-- Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent, be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of `—/`Date when contractor will begin contracted work. MGL chapter 142A.) a� "Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of. M Payments will be made according to the following schedule: $ 0O U upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by —4---4— or upon completion-of $ by _F=7=.or upon completion of $ lD o o upon completion of the contract. (Law forbids demanding full payment until contract is completed to both patty's satisfaction) The following material/equipment must be special $ DO 0 to be paid for W i/v �oW.f -rldl, ordered before the contracted work begins in order S to be paid for 1 to meet the completion schedule.(**) NOTES:(')Including all finance charges(•')Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warrauh,-is an express warranty being provided by the contractor? o all rity must be attached to the contract) Subcontractors-TheTontractor agrees to be solely responsible for comple on of the work described regardless of the actions of any third patty/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this-agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract • Don't be pressured into signing the contract Take time to read and fully understand it Ask questions if something is unclear, • Make sure the contractor has a valid Home Improvement Contractor Registration The law requires most home improvement contractors and subcontractors to be registered with die Director of Home Itnprovement Contractor Registration. You may inquire about contractor registration by,writing to the Director at One Ashburton Place,Room 1301,Boston,MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's.normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day following,the signing of this agreement. See the attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPAC III Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be Icep y the con etor. Homeowner's Signature Contractor's Signa re Date Date Perm/ Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an . alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the cons r s 11.be re uired to submit to such arbit tion as provided In Massachusetts General Laws,chapter 142A. Homeowner's Signature Contractor's. ignature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this stiction is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor i.s responsible for completing the work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts catty an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until.a copy of all exhibits and referenced documents have been.attached. Parties are-also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner°and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day recission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems hindherself to be financially insecure. However,in instances wherea contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work, Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or-tf you wish to obtain a free copy of "A Consumer Guide to the Home Improvement Contractor Law,"contact: Consumer Infortnation Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)2833757 If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement'Contractor Registration Bureau of Building Regulations and Standards One Ashburton Place,Room 1301,Boston,MA 02108 (617)727-3200 or 1-800-223-0933 For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General (617)727-8400 AND/OR' Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 11290—/loneoraer. I•aau,25-53Wamsrr.n0x.c= t` H PRODUCT 218 Proposal Page No. of Pages BRAD POWERS CONSTRUCTION 1010 22 Wymans Landing DANVILLE, NH 03819 (603) 642-64280(603) 235-7986 PROPOSAL SUBMITTED TO PHONE DATE ! olvl,e /�¢9 3 STREET JOB NAME D/ /�1 i�C L4N CITY,STATE and ZIP ODE4 JOB LOCATION ARCHITECT DATE OF PLANS JOB PHONE P r0 OSP hereby to furnish material and labor complete in accordance with specifications below,for the sum of: #,� � Y P P: .5-0 7. Payment to be made/as follows: dollars($ ��r M _------- All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from specifications be- Authorized low involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,acci- dents or delays beyond our control:Owner to carry fire,tornado and other necessary Note:This proposal may be insurance.Our workers are fully covered by Workman's Compensation Insurance. withdrawn by us if not accepted within days. We hereby submit specifications and estimates for: , .. ..... ... .. . ....... .. . . .......... .... a} � /c;Cr` fro v �� �j uN G✓�' '� Ups <,,v �v�% eNf� / _ I�1y ers- �_ ?�Wa /�� �i✓_._./ �. I Jf/ ,� /U,qTvTkZ (. /N G✓/. /l�f�l' �� SNAp -_e_ 1 V wilv��rry r rv �� s rr� s ,v x r, '1�0.._C l M e� 4'✓ 40— l/P l"�%, �� /`i'i N� © r �_ /a J T® rQUN _... ... v C)r/.� �U •r ��PD 11 ©.t f! /yli9 Te i'i s ,uGP / Ile; _ . ZA Arreptaurr of Proposal The above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorized Signature 31i to do the work as specified.Payment will be made as outlined above. Date of Acceptance: Signature i Massachusetts- Department or Public Saret- Board of Building Revelations and Standards` Construction Supervisor License License: CS 48810 Restricted to: 00 BRADLEY E POWERS JR j 22 WYMAN'S LANDING 1J DANVILLE, NH 03819 Concrete Tech-CT 1{ � Expiration: 8/3/2011 i ('ununissirner Tr#: 1515 Board oor nui� n a nand tan arils HOME IMPROVEMENT CONTRACTOR ' Registrat 66,; 122776 Expiration'._10116/2010 Tr# 275594 Type pBA BRAD POWERS CONSTRUCTION:, BRADLEY POWERS'- . 22 WYMANS LANDING4 sf OANVILLE,NH 03819 �., ,— Administrator r_ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, JVA 02111 kiv www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ,Q Please Print Legibly Name(Business/Organiza6on/Individual): fy\ 4%71 Address: p`Zo2 LA gluS -i7/vWl i City/State/Zip: /U V/`fie /�/� DV/*hone Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I Type of project(required): em oyees(full and/or part-time).* have hired the sub-contractors 6• ❑,New construction 2. 'Lf',am a sole proprietor or partner- listed on the attached sheet 1 7• Kemodehng ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. workers' comp.insurance. [No workers' comp. insurance 5. 9• Building addition p ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no insurance required.] t employees_ [No workers' 12.E]Roof repairs insurance surance required.] 13.❑ Other ".ny applicant that checks box uI must also fill out the section below p.inn^ r workers"compensation poo"cy _ Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mustsubmit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' under the p i an`d�pe tie of perjury tha the information provided above is true and correct Simature: b` Date.: CP Phone#: O 3 s= I O (O Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing:Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be ret-arned to the cis or towm that the application for the permit or license is being requested,not the Department.of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street Boston,MA 02111 Tel. # 617-72.7-4900 ext 406 or 1-8 77-MASSAFE Fax#617-727-7749 Revised 5-26-QS vvvm7.ma&s.gov/dia NORTIy Town of over * LAKE y c dover, Mass., COC MIC MEWICK �d ADRA7ED `S BOARD OF HEALTH PER IT T Food/Kitchen Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT........... .... .. /'►R( lA.l.( .....��4.A-0AV..&W10 .' ............................................... Foundation has permission to erect................... .................... buildings on .... .1......... 4.1.I!K t.�r.........1 .�.....�...�.. ............... Rough to be occupied as... ....W.i.!'4Q.!�Ir�?�.....' '... I�.�!.!.! ....iV...N�'ti M►...;.JAILItr�.J) �... chimney provided that the person accepting this permit shall in every respect conform to the termf the application on file inin F al this office; and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough .......... ................................................. Service BUILDING INSPECTOR ' Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner FlRE DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det.